Sanjeev (58), physically fit but diagnosed with AFib, seeks medical insurance advice

I am Sanjeev Kumar, aged 58, working with a reputed public limited company at a senior level. Our company mandates annual health check up from reputed hospitals in Delhi and I am covered under a floater medical insurance plan. I was diagnosed with Atrial fibrillation more than a couple of years ago and taking two tablets per day (one Beta blocker and one blood thinner) as a precaution as per doctor. Otherwise I am physically fit and active (I successfully run half marathon for last more than 10 years). I intend to have another medical indurance as I am approaching retirement age but insurance companies are reluctant to provide me the same. Please advise what type of medical insurance cover I should have (for self and my wife, 55 yrs) and from which companies! Is online plan okay?

Ans: Hello;

If you have a known illness of the heart unfortunately hardly any general insurance company will come forward to cover you despite other positives.

Because insurance works on probability and when they reckon that probability of claim, in future based on current information, may be high they refuse to underwrite such risks.

Since you are an employee of a public sector company, I suppose your employer may have some group mediclaim plan or coverage for the retirees as well.

Take that coverage even if you have to pay and undergo a waiting period.

Alternatively you may earmark some fixed sum 8-10 L as medical contingency fund for yourself.

For your spouse you should opt for a minimum 25 L healthcare cover from companies such as HDFC Ergo, ICICI Lombard, Bajaj Allianz, SBI General etc which do not entirely depend on healthcare insurance as the only business segment.

Best wishes;

Ans: Choosing the right health insurance for your family is a crucial decision. I understand that this process can be overwhelming, especially with the numerous options available in the market. Let’s explore this step-by-step to ensure that you select the best health insurance plan tailored to your family’s needs.

Understanding Health Insurance
Health insurance is essential to safeguard against unexpected medical expenses. It covers hospitalization, treatments, surgeries, and sometimes even preventive care.

Having health insurance gives you peace of mind, knowing that you won't have to bear the entire financial burden in case of medical emergencies.

Assessing Your Family’s Health Needs
To choose the right health insurance, you need to assess the specific health needs of your family.

Consider Your Age and Health Status
At 62 years old, your health needs may be different from those of your wife, who is 56, and your children, who are 25 and 20 years old. Older individuals typically require more frequent medical attention and might have pre-existing conditions.

Pre-existing Conditions
If any family member has pre-existing conditions, ensure the policy covers these after a waiting period. This is crucial for avoiding out-of-pocket expenses.

Coverage for Hospitalization and Surgeries
Ensure that the policy covers hospitalization and surgeries. Medical costs can be very high, and comprehensive coverage will protect you from significant financial strain.

Comparing Different Policies
When comparing health insurance policies, consider the following factors:

Sum Insured
Choose a sum insured that is sufficient to cover the potential medical expenses for the entire family. In metropolitan cities, medical costs can be higher, so opt for a higher sum insured if you reside in such areas.

Network Hospitals
Check if the insurance provider has a wide network of hospitals. Cashless hospitalization in network hospitals simplifies the process and reduces financial stress during emergencies.

Sub-limits and Co-payments
Some policies have sub-limits on room rent or specific treatments and co-payment clauses. Understand these limitations to avoid unexpected expenses.

Waiting Periods
Understand the waiting periods for pre-existing diseases, maternity benefits, and other specific treatments. Shorter waiting periods are more advantageous.

Family Floater Plans vs. Individual Plans
A family floater plan covers all family members under a single sum insured, while individual plans provide separate coverage for each member.

Family Floater Plans
Family floater plans are usually more cost-effective and simpler to manage. The sum insured is shared among all members, which is beneficial if no major health issues are anticipated simultaneously.

Individual Plans
Individual plans can be more suitable if family members have varying health needs or if older members need higher coverage. Separate policies ensure that one member’s high medical expenses do not exhaust the entire sum insured.

Critical Illness Coverage
Consider adding critical illness coverage to your health insurance. This provides a lump sum payment upon diagnosis of severe illnesses such as cancer, heart attack, or stroke.

Maternity Benefits and Newborn Coverage
If there’s a possibility of expanding your family, check if the policy includes maternity benefits and coverage for newborns.

Premiums and Affordability
While choosing a policy, balance between comprehensive coverage and affordability. Higher premiums usually mean better coverage, but ensure it fits within your budget.

Additional Benefits and Riders
Explore additional benefits like wellness programs, free health check-ups, and disease-specific riders. These add value to your policy.

Evaluating Insurance Providers
Choosing a reliable insurance provider is as important as selecting the right policy.

Claim Settlement Ratio
The claim settlement ratio indicates the percentage of claims settled by the insurer. A higher ratio reflects reliability.

Customer Service
Evaluate the insurer’s customer service. Prompt and efficient service is crucial during medical emergencies.

Reviews and Recommendations
Read reviews and seek recommendations from friends, family, or a Certified Financial Planner to make an informed decision.

Portability Options
If you’re not satisfied with your current insurance provider, check the portability options. This allows you to switch insurers without losing benefits.

Government Schemes and Tax Benefits
Explore government health schemes for additional coverage. Also, health insurance premiums offer tax benefits under Section 80D of the Income Tax Act.

Conclusion
Choosing the right health insurance involves thorough research and understanding your family’s specific needs. Consider the factors mentioned above to make an informed decision.

Remember, investing time in selecting the right policy can save you from financial stress during medical emergencies.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in